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False-negative rate cannot be reduced by lowering the haemoglobin concentration cut-off in colorectal cancer screening using faecal immunochemical test

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The aim of this study was to analyse false-negative (FN) results of the faecal immunochemical test (FIT) and its determinants in a colorectal cancer screening programme in Catalonia. We carried out a cross-sectional study among 218 screenees with a negative FIT result who agreed to undergo a colonoscopy. A false-negative result was defined as the detection, at colonoscopy, of intermediate/high-risk polyps or colorectal cancer in a patient with a previous negative FIT (<20 µgHb/g). Multivariate logistic regression models were constructed to identify sociodemographic (sex, age) and screening variables (quantitative faecal haemoglobin, colonoscopy findings) related to FN results. Adjusted odds ratios and their 95% confidence intervals were estimated. There were 15.6% FN FIT results. Faecal haemoglobin was undetected in 45.5% of these results and was below 4 µgHb/g in 94.0% of the individuals with a FN result. About 60% of the lesions were located in the proximal colon, whereas the expected percentage was 30%. Decreasing the positivity threshold of FIT does not increase the detection rate of advanced neoplasia, but may increase the costs and potential adverse effects.
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Keywords: adverse effects; colorectal cancer screening; faecal immunochemical test; false negative

Document Type: Research Article

Affiliations: 1: Cancer Prevention and Control Programme, Catalan Institute of Oncology, IDIBELL 2: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp) 3: Department of Gastroenterology and Hepatology, Hospital of Viladecans, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain 4: Cancer Prevention and Control Programme, Catalan Institute of Oncology, IDIBELL, Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

Publication date: September 1, 2017

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